Malpractice Case: Beware of the Agreeable, Noncompliant Patient

Gordon T. Ownby

Disclosures

April 25, 2018

Knowing a Patient Well Can Interfere With Good Judgment

Medscape Editor’s Key Points

  • Knowing a patient and family for many years, or even decades, is no guarantee that the patient who seems agreeable will adhere to your instructions to follow up with tests that may detect a life-threatening condition.

  • Even though a patient may be guilty of inaction in undergoing a recommended test, they can sue you for a delayed diagnosis, especially if you don't have written or oral policies, procedures, or a practice for documenting conversations with patients about life-threatening illnesses.

  • There is a difference between patients who refuse to undergo a test versus those who simply delay action.

Though many physicians lament modern medicine's tendency to treat patients like numbers, sometimes knowing a patient and family too well can interfere with good judgment.

Dr FP, a family practitioner, had been treating his amicable, 45-year-old patient for some 20 years. The patient, a SCUBA dive travel operator, complained during one visit of pains along her backside for the past 6 months. On examination, Dr FP found chest and abdominal pain, plus shortness of breath. He ordered a complete blood workup, other lab evaluation, and an abdominal CT scan.

The CT scan showed a solid-appearing mass in the left midlateral kidney. The radiologist telephoned Dr FP twice about his suspicion of cancer and recommended a bone scan and an abdominal ultrasound of the left kidney. Dr FP advised the patient of the findings and of his plan to refer her to a urologist after the two additional studies were done.

Doctor Reminds Patient to Schedule Test

Dr FP's clinic called the patient to let her know that it had scheduled the ultrasound and bone scan tests, both to be done on the same day. The patient went for the bone scan but did not show up for the ultrasound. On the day after the scan, Dr FP's clinic called the patient to let her know that the scan was negative.

Six weeks later, the patient returned to Dr FP complaining of body aches, sinus pain, and a scratchy throat. Dr FP treated the patient for an upper respiratory infection and took a throat culture. During the visit, Dr FP reminded the patient to schedule the abdominal ultrasound and gave the patient the telephone number to schedule the appointment.

Dr FP called his patient back a week later, leaving a message on her telephone machine stating that she had a bacterial infection and that she should finish the medications prescribed to her. He also stated (and charted) his advice to "Don't forget to schedule the ultrasound."

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